Skip to main content
Top
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Podoconiosis patients’ willingness to pay for treatment services in Northwest Ethiopia: potential for cost recovery

Authors: Abreham Tamiru, Girmay Tsegay, Moges Wubie, Molla Gedefaw, Sara Tomczyk, Fasil Tekola-Ayele

Published in: BMC Public Health | Issue 1/2014

Login to get access

Abstract

Background

Podoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine podoconiosis patient’s willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia.

Methods

A cross-sectional study was conducted among randomly selected untreated podoconiosis patients (n = 393) in Baso Liben woreda, northwestern Ethiopia. The contingent valuation method was used with a pre-tested interviewer-administered questionnaire.

Results

The majority of podoconiosis patients (72.8%) were willing to pay for treatment services. The median WTP amount was 64 Birr (US$ 3.28) per person per year. More than one-third of patients (36.7%) were willing to pay at least half of the full treatment cost and 76.2% were willing to pay at least half of the cost of shoes. A multivariate analysis showed that having a higher monthly income, being a woman, older age, being aware of the role of shoes to prevent podoconiosis, and possession of a functional radio were significantly associated with higher odds of WTP.

Conclusions

The considerable WTP estimates showed that podoconiosis treatment could improve sustainability and service utilization. A subsidized cost recovery scheme could reduce treatment costs and more feasibility integrate podoconiosis treatment service with other NTDs and the government’s primary health care system.
Appendix
Available only for authorised users
Literature
1.
go back to reference Price E: Podoconiosis: Non-Filarial Elephantiasis. 1990, Oxford: Oxford Medical Price E: Podoconiosis: Non-Filarial Elephantiasis. 1990, Oxford: Oxford Medical
2.
go back to reference Price EW: A possible genetic factor in non-filarial elephantiasis of the lower legs. Ethiop Med J. 1972, 10 (3): 87-93.PubMed Price EW: A possible genetic factor in non-filarial elephantiasis of the lower legs. Ethiop Med J. 1972, 10 (3): 87-93.PubMed
3.
go back to reference Davey G, Gebrehanna E, Adeyemo A, Rotimi C, Newport M, Desta K: Podoconiosis: a tropical model for gene-environment interactions?. Trans R Soc Trop Med Hyg. 2007, 101 (1): 91-96. 10.1016/j.trstmh.2006.05.002.CrossRefPubMed Davey G, Gebrehanna E, Adeyemo A, Rotimi C, Newport M, Desta K: Podoconiosis: a tropical model for gene-environment interactions?. Trans R Soc Trop Med Hyg. 2007, 101 (1): 91-96. 10.1016/j.trstmh.2006.05.002.CrossRefPubMed
4.
go back to reference Tekola Ayele F, Adeyemo A, Finan C, Hailu E, Sinnott P, Burlinson ND, Aseffa A, Rotimi CN, Newport MJ, Davey G: HLA class II locus and susceptibility to podoconiosis. N Engl J Med. 2012, 366 (13): 1200-1208. 10.1056/NEJMoa1108448.CrossRefPubMed Tekola Ayele F, Adeyemo A, Finan C, Hailu E, Sinnott P, Burlinson ND, Aseffa A, Rotimi CN, Newport MJ, Davey G: HLA class II locus and susceptibility to podoconiosis. N Engl J Med. 2012, 366 (13): 1200-1208. 10.1056/NEJMoa1108448.CrossRefPubMed
5.
go back to reference Wanji S, Tendongfor N, Esum M, Che JN, Mand S, Tanga Mbi C, Enyong P, Hoerauf A: Elephantiasis of non-filarial origin (podoconiosis) in the highlands of north-western Cameroon. Ann Trop Med Parasitol. 2008, 102 (6): 529-540. 10.1179/136485908X311849.CrossRefPubMed Wanji S, Tendongfor N, Esum M, Che JN, Mand S, Tanga Mbi C, Enyong P, Hoerauf A: Elephantiasis of non-filarial origin (podoconiosis) in the highlands of north-western Cameroon. Ann Trop Med Parasitol. 2008, 102 (6): 529-540. 10.1179/136485908X311849.CrossRefPubMed
6.
go back to reference Davey G, Tekola F, Newport MJ: Podoconiosis: non-infectious geochemical elephantiasis. Trans R Soc Trop Med Hyg. 2007, 101 (12): 1175-1180. 10.1016/j.trstmh.2007.08.013.CrossRefPubMed Davey G, Tekola F, Newport MJ: Podoconiosis: non-infectious geochemical elephantiasis. Trans R Soc Trop Med Hyg. 2007, 101 (12): 1175-1180. 10.1016/j.trstmh.2007.08.013.CrossRefPubMed
7.
go back to reference Tekola F, Mariam DH, Davey G: Economic costs of endemic non-filarial elephantiasis in Wolaita Zone, Ethiopia. Trop Med Int Health. 2006, 11 (7): 1136-1144. 10.1111/j.1365-3156.2006.01658.x.CrossRefPubMed Tekola F, Mariam DH, Davey G: Economic costs of endemic non-filarial elephantiasis in Wolaita Zone, Ethiopia. Trop Med Int Health. 2006, 11 (7): 1136-1144. 10.1111/j.1365-3156.2006.01658.x.CrossRefPubMed
8.
go back to reference Yakob B, Deribe K, Davey G: High levels of misconceptions and stigma in a community highly endemic for podoconiosis in southern Ethiopia. Trans R Soc Trop Med Hyg. 2008, 102 (5): 439-444. 10.1016/j.trstmh.2008.01.023.CrossRefPubMed Yakob B, Deribe K, Davey G: High levels of misconceptions and stigma in a community highly endemic for podoconiosis in southern Ethiopia. Trans R Soc Trop Med Hyg. 2008, 102 (5): 439-444. 10.1016/j.trstmh.2008.01.023.CrossRefPubMed
9.
go back to reference Tekola F, Bull S, Farsides B, Newport MJ, Adeyemo A, Rotimi CN, Davey G: Impact of social stigma on the process of obtaining informed consent for genetic research on podoconiosis: a qualitative study. BMC Med Ethics. 2009, 10: 13-10.1186/1472-6939-10-13.CrossRefPubMedPubMedCentral Tekola F, Bull S, Farsides B, Newport MJ, Adeyemo A, Rotimi CN, Davey G: Impact of social stigma on the process of obtaining informed consent for genetic research on podoconiosis: a qualitative study. BMC Med Ethics. 2009, 10: 13-10.1186/1472-6939-10-13.CrossRefPubMedPubMedCentral
10.
go back to reference Sikorski C, Ashine M, Zeleke Z, Davey G: Effectiveness of a simple lymphoedema treatment regimen in podoconiosis management in southern ethiopia: one year follow-up. PLoS Negl Trop Dis. 2010, 4 (11): e902-10.1371/journal.pntd.0000902.CrossRefPubMedPubMedCentral Sikorski C, Ashine M, Zeleke Z, Davey G: Effectiveness of a simple lymphoedema treatment regimen in podoconiosis management in southern ethiopia: one year follow-up. PLoS Negl Trop Dis. 2010, 4 (11): e902-10.1371/journal.pntd.0000902.CrossRefPubMedPubMedCentral
11.
go back to reference Tekola Ayele F, Adeyemo A, Rotimi CN: Using a “genomics tool” to develop disease prevention strategy in a low-income setting: lessons from the podoconiosis research project. J Community Genet. 2012, 3 (4): 303-309. 10.1007/s12687-012-0086-0.CrossRefPubMedPubMedCentral Tekola Ayele F, Adeyemo A, Rotimi CN: Using a “genomics tool” to develop disease prevention strategy in a low-income setting: lessons from the podoconiosis research project. J Community Genet. 2012, 3 (4): 303-309. 10.1007/s12687-012-0086-0.CrossRefPubMedPubMedCentral
12.
go back to reference Tomczyk S, Tamiru A, Davey G: Addressing the neglected tropical disease podoconiosis in Northern Ethiopia: lessons learned from a new community podoconiosis program. PLoS Negl Trop Dis. 2012, 6 (3): e1560-10.1371/journal.pntd.0001560.CrossRefPubMedPubMedCentral Tomczyk S, Tamiru A, Davey G: Addressing the neglected tropical disease podoconiosis in Northern Ethiopia: lessons learned from a new community podoconiosis program. PLoS Negl Trop Dis. 2012, 6 (3): e1560-10.1371/journal.pntd.0001560.CrossRefPubMedPubMedCentral
13.
go back to reference CSA & ORC Macro: The 2007 Population and Housing Census of Ethiopia. 2007, Addis Ababa: CSA CSA & ORC Macro: The 2007 Population and Housing Census of Ethiopia. 2007, Addis Ababa: CSA
14.
go back to reference Klose T: The contingent valuation method in health care. Health Policy. 1999, 47 (2): 97-123. 10.1016/S0168-8510(99)00010-X.CrossRefPubMed Klose T: The contingent valuation method in health care. Health Policy. 1999, 47 (2): 97-123. 10.1016/S0168-8510(99)00010-X.CrossRefPubMed
15.
go back to reference Tekola F, Ayele Z, Mariam DH, Fuller C, Davey G: Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis). Trop Med Int Health. 2008, 13 (10): 1277-1283. 10.1111/j.1365-3156.2008.02133.x.CrossRefPubMedPubMedCentral Tekola F, Ayele Z, Mariam DH, Fuller C, Davey G: Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis). Trop Med Int Health. 2008, 13 (10): 1277-1283. 10.1111/j.1365-3156.2008.02133.x.CrossRefPubMedPubMedCentral
16.
go back to reference Prata N, Bell S, Weidert K, Gessessew A: Potential for cost recovery: women’s willingness to pay for injectable contraceptives in Tigray, Ethiopia. PLoS One. 2013, 8 (5): e64032-10.1371/journal.pone.0064032.CrossRefPubMedPubMedCentral Prata N, Bell S, Weidert K, Gessessew A: Potential for cost recovery: women’s willingness to pay for injectable contraceptives in Tigray, Ethiopia. PLoS One. 2013, 8 (5): e64032-10.1371/journal.pone.0064032.CrossRefPubMedPubMedCentral
17.
go back to reference Gebresilassie FE, Mariam DH: Factors influencing people’s willingness-to-buy insecticide-treated bednets in Arbaminch Zuria District, southern Ethiopia. J Health Popul Nutr. 2011, 29 (3): 200-206.CrossRefPubMedPubMedCentral Gebresilassie FE, Mariam DH: Factors influencing people’s willingness-to-buy insecticide-treated bednets in Arbaminch Zuria District, southern Ethiopia. J Health Popul Nutr. 2011, 29 (3): 200-206.CrossRefPubMedPubMedCentral
18.
go back to reference Segre J, Winnard K, Abrha TH, Abebe Y, Shilane D, Lapping K: Willingness to pay for lipid-based nutrient supplements for young children in four urban sites of Ethiopia. Matern Child Nutr. 2012, 6: 81-93. Segre J, Winnard K, Abrha TH, Abebe Y, Shilane D, Lapping K: Willingness to pay for lipid-based nutrient supplements for young children in four urban sites of Ethiopia. Matern Child Nutr. 2012, 6: 81-93.
19.
go back to reference Molla YB, Tomczyk S, Amberbir T, Tamiru A, Davey G: Podoconiosis in East and West Gojam Zones, Northern Ethiopia. PLoS Negl Trop Dis. 2012, 6 (7): e1744-10.1371/journal.pntd.0001744.CrossRefPubMedPubMedCentral Molla YB, Tomczyk S, Amberbir T, Tamiru A, Davey G: Podoconiosis in East and West Gojam Zones, Northern Ethiopia. PLoS Negl Trop Dis. 2012, 6 (7): e1744-10.1371/journal.pntd.0001744.CrossRefPubMedPubMedCentral
20.
go back to reference Molla YB, Tomczyk S, Amberbir T, Tamiru A, Davey G: Patients’ perceptions of podoconiosis causes, prevention and consequences in East and West Gojam, Northern Ethiopia. BMC Public Health. 2012, 12: 828-10.1186/1471-2458-12-828.CrossRefPubMedPubMedCentral Molla YB, Tomczyk S, Amberbir T, Tamiru A, Davey G: Patients’ perceptions of podoconiosis causes, prevention and consequences in East and West Gojam, Northern Ethiopia. BMC Public Health. 2012, 12: 828-10.1186/1471-2458-12-828.CrossRefPubMedPubMedCentral
21.
go back to reference Sherrod D, Downs R: Environmental determinants of altruism: the effects of stimulus overload and perceived control on helping. J Exp Soc Psychol. 1974, 10: 468-479. 10.1016/0022-1031(74)90015-8.CrossRef Sherrod D, Downs R: Environmental determinants of altruism: the effects of stimulus overload and perceived control on helping. J Exp Soc Psychol. 1974, 10: 468-479. 10.1016/0022-1031(74)90015-8.CrossRef
22.
go back to reference Alemu G, Tekola Ayele F, Daniel T, Ahrens C, Davey G: Burden of podoconiosis in poor rural communities in Gulliso woreda, West Ethiopia. PLoS Negl Trop Dis. 2011, 5 (6): e1184-10.1371/journal.pntd.0001184.CrossRefPubMedPubMedCentral Alemu G, Tekola Ayele F, Daniel T, Ahrens C, Davey G: Burden of podoconiosis in poor rural communities in Gulliso woreda, West Ethiopia. PLoS Negl Trop Dis. 2011, 5 (6): e1184-10.1371/journal.pntd.0001184.CrossRefPubMedPubMedCentral
23.
go back to reference Tekola Ayele F, Alemu G, Davey G, Ahrens C: Community-based survey of podoconiosis in Bedele Zuria woreda, West Ethiopia. Int Health. 2013, 5 (2): 119-125. 10.1093/inthealth/iht003.CrossRefPubMedPubMedCentral Tekola Ayele F, Alemu G, Davey G, Ahrens C: Community-based survey of podoconiosis in Bedele Zuria woreda, West Ethiopia. Int Health. 2013, 5 (2): 119-125. 10.1093/inthealth/iht003.CrossRefPubMedPubMedCentral
24.
go back to reference Geshere Oli G, Tekola Ayele F, Petros B: Parasitological, serological and clinical evidence for high prevalence of podoconiosis (non-filarial elephantiasis) in Midakegn District, Central Ethiopia. Trop Med Int Health. 2012, 17 (6): 722-726. 10.1111/j.1365-3156.2012.02978.x.CrossRefPubMed Geshere Oli G, Tekola Ayele F, Petros B: Parasitological, serological and clinical evidence for high prevalence of podoconiosis (non-filarial elephantiasis) in Midakegn District, Central Ethiopia. Trop Med Int Health. 2012, 17 (6): 722-726. 10.1111/j.1365-3156.2012.02978.x.CrossRefPubMed
25.
go back to reference Ayode D, McBride CM, de Heer HD, Watanabe E, Gebreyesus T, Tora A, Tadele G, Davey G: A qualitative study exploring barriers related to use of footwear in rural highland ethiopia: implications for neglected tropical disease control. PLoS Negl Trop Dis. 2013, 7 (4): e2199-10.1371/journal.pntd.0002199.CrossRefPubMedPubMedCentral Ayode D, McBride CM, de Heer HD, Watanabe E, Gebreyesus T, Tora A, Tadele G, Davey G: A qualitative study exploring barriers related to use of footwear in rural highland ethiopia: implications for neglected tropical disease control. PLoS Negl Trop Dis. 2013, 7 (4): e2199-10.1371/journal.pntd.0002199.CrossRefPubMedPubMedCentral
26.
go back to reference USAID: Health Care Financing Reforem in Ethiopia: Improving Quality and Equity. Health Systems 20/20 Project. USAID; 2012,2(2):1–12 USAID: Health Care Financing Reforem in Ethiopia: Improving Quality and Equity. Health Systems 20/20 Project. USAID; 2012,2(2):1–12
Metadata
Title
Podoconiosis patients’ willingness to pay for treatment services in Northwest Ethiopia: potential for cost recovery
Authors
Abreham Tamiru
Girmay Tsegay
Moges Wubie
Molla Gedefaw
Sara Tomczyk
Fasil Tekola-Ayele
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-259

Other articles of this Issue 1/2014

BMC Public Health 1/2014 Go to the issue